Keeping Obstetrics Local Act

Who is affected and how:

• Pregnant and postpartum people: Direct beneficiaries through an extension to 12 months of full Medicaid/CHIP coverage after pregnancy, presumptive eligibility to speed enrollment, expanded screening for postpartum depression and anxiety, and potential increased access to doulas and other maternal health professionals if states follow HHS guidance.

• Hospitals (including critical access and rural hospitals): Required to collect and report detailed maternity cost and obstetric service data, face notice and public-reporting requirements before obstetric unit closures, and may receive federal help for data collection. Hospitals experiencing workforce shortages could receive temporary federal Commissioned Corps staffing, but hospitals also face new administrative and reporting duties.

• Maternal health workforce (clinicians, doulas, midwives, nurses): May see strengthened support, clearer pathways for coordination through the maternity health home model, and opportunities for reimbursement if states adopt HHS guidance. Workforce surge support is enabled through Commissioned Corps detailing during urgent needs.

• State governments and Medicaid/CHIP programs: Must run and report statewide hospital cost studies, post closure reports publicly, implement coverage expansions and presumptive eligibility rules, and handle new planning and administrative tasks; some federal funding is authorized, but states will incur implementation costs and responsibilities.

• Rural and underserved communities: Targeted for federal support to collect cost data and to preserve maternal services; strengthened transparency and surge staffing aim to reduce local service gaps when facilities close or lose staff.

• Federal agencies (HHS / Secretary of HHS): Required to receive and publish State study results, issue guidance on coverage (doula services, out-of-State provider enrollment), manage Commissioned Corps detailing and funding, and oversee compliance with reporting timelines.

Potential positive outcomes:

• Better data to understand and address mismatches between costs and reimbursement for maternity care.
• Longer postpartum insurance coverage may improve maternal and infant outcomes and increase access to needed services.
• Faster federal response to local shortages and clearer public notice of obstetric service risks.

Potential burdens/risks:

• New reporting and study obligations for States and hospitals could require staffing and systems investments; while some funds are authorized, not all costs may be fully funded, creating implementation challenges.
• Implementation will depend on state adoption of the maternity health home model and HHS guidance, so benefits will vary by state.
• Hospitals facing closure may still experience service gaps even with notice requirements; detailing of Corps personnel is temporary and requires local planning for sustainable staffing.